|
TIB GNS II CMT W/O TAPER SZ7 L
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
TIB GNS II CMT W/O TAPER SZ7 R
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
TIB GNS II CMT W/O TAPER SZ7 R
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
TIB GNS II CMT W/O TAPER SZ8 L
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
TIB GNS II CMT W/O TAPER SZ8 L
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
TIB GNS II CMT W/O TAPER SZ8 R
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
TIB GNS II CMT W/O TAPER SZ8 R
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
TIBIA END CAP 11.5 +5MM
|
Facility
|
IP
|
$1,907.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.34 |
| Max. Negotiated Rate |
$1,831.50 |
| Rate for Payer: Aetna Commercial |
$1,469.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.09
|
| Rate for Payer: Cash Price |
$953.90
|
| Rate for Payer: Cigna Commercial |
$1,583.48
|
| Rate for Payer: First Health Commercial |
$1,812.42
|
| Rate for Payer: Humana Commercial |
$1,621.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,678.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,430.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.39
|
| Rate for Payer: PHCS Commercial |
$1,831.50
|
| Rate for Payer: United Healthcare All Payer |
$1,678.87
|
|
|
TIBIA END CAP 11.5 +5MM
|
Facility
|
OP
|
$1,907.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.34 |
| Max. Negotiated Rate |
$1,831.50 |
| Rate for Payer: Aetna Commercial |
$1,469.01
|
| Rate for Payer: Anthem Medicaid |
$656.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.09
|
| Rate for Payer: Cash Price |
$953.90
|
| Rate for Payer: Cigna Commercial |
$1,583.48
|
| Rate for Payer: First Health Commercial |
$1,812.42
|
| Rate for Payer: Humana Commercial |
$1,621.64
|
| Rate for Payer: Humana KY Medicaid |
$656.10
|
| Rate for Payer: Kentucky WC Medicaid |
$662.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$669.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,678.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,430.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.39
|
| Rate for Payer: PHCS Commercial |
$1,831.50
|
| Rate for Payer: United Healthcare All Payer |
$1,678.87
|
|
|
TIBIA FIXED BEARING 2-PEG F
|
Facility
|
IP
|
$11,170.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,351.09 |
| Max. Negotiated Rate |
$10,723.49 |
| Rate for Payer: Aetna Commercial |
$8,601.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,712.83
|
| Rate for Payer: Cash Price |
$5,585.15
|
| Rate for Payer: Cigna Commercial |
$9,271.35
|
| Rate for Payer: First Health Commercial |
$10,611.78
|
| Rate for Payer: Humana Commercial |
$9,494.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,159.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,243.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,351.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,829.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,377.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,936.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,718.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,707.51
|
| Rate for Payer: PHCS Commercial |
$10,723.49
|
| Rate for Payer: United Healthcare All Payer |
$9,829.86
|
|
|
TIBIA FIXED BEARING 2-PEG F
|
Facility
|
OP
|
$11,170.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,351.09 |
| Max. Negotiated Rate |
$10,723.49 |
| Rate for Payer: Aetna Commercial |
$8,601.13
|
| Rate for Payer: Anthem Medicaid |
$3,841.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,712.83
|
| Rate for Payer: Cash Price |
$5,585.15
|
| Rate for Payer: Cigna Commercial |
$9,271.35
|
| Rate for Payer: First Health Commercial |
$10,611.78
|
| Rate for Payer: Humana Commercial |
$9,494.75
|
| Rate for Payer: Humana KY Medicaid |
$3,841.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,880.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,159.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,243.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,351.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,918.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,829.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,377.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,936.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,718.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,707.51
|
| Rate for Payer: PHCS Commercial |
$10,723.49
|
| Rate for Payer: United Healthcare All Payer |
$9,829.86
|
|
|
TIBIAL ANCHOR 9*25
|
Facility
|
IP
|
$1,691.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.31 |
| Max. Negotiated Rate |
$1,623.38 |
| Rate for Payer: Aetna Commercial |
$1,302.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,319.00
|
| Rate for Payer: Cash Price |
$845.51
|
| Rate for Payer: Cigna Commercial |
$1,403.55
|
| Rate for Payer: First Health Commercial |
$1,606.47
|
| Rate for Payer: Humana Commercial |
$1,437.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,386.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,247.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$507.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,488.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,268.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,352.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,471.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.80
|
| Rate for Payer: PHCS Commercial |
$1,623.38
|
| Rate for Payer: United Healthcare All Payer |
$1,488.10
|
|
|
TIBIAL ANCHOR 9*25
|
Facility
|
OP
|
$1,691.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.31 |
| Max. Negotiated Rate |
$1,623.38 |
| Rate for Payer: Aetna Commercial |
$1,302.09
|
| Rate for Payer: Anthem Medicaid |
$581.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,319.00
|
| Rate for Payer: Cash Price |
$845.51
|
| Rate for Payer: Cigna Commercial |
$1,403.55
|
| Rate for Payer: First Health Commercial |
$1,606.47
|
| Rate for Payer: Humana Commercial |
$1,437.37
|
| Rate for Payer: Humana KY Medicaid |
$581.54
|
| Rate for Payer: Kentucky WC Medicaid |
$587.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,386.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,247.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$507.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$593.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,488.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,268.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,352.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,471.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.80
|
| Rate for Payer: PHCS Commercial |
$1,623.38
|
| Rate for Payer: United Healthcare All Payer |
$1,488.10
|
|
|
TIBIAL ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,725.00
|
|
|
Service Code
|
HCPCS 29855
|
| Hospital Charge Code |
76101091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$517.50 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$1,328.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,345.50
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cigna Commercial |
$1,431.75
|
| Rate for Payer: First Health Commercial |
$1,638.75
|
| Rate for Payer: Humana Commercial |
$1,466.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,414.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,273.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$517.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,518.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,293.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,500.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,190.25
|
| Rate for Payer: PHCS Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare All Payer |
$1,518.00
|
|
|
TIBIAL ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,725.00
|
|
|
Service Code
|
HCPCS 29855
|
| Hospital Charge Code |
76101091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$593.23 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,328.25
|
| Rate for Payer: Anthem Medicaid |
$593.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,345.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cigna Commercial |
$1,431.75
|
| Rate for Payer: First Health Commercial |
$1,638.75
|
| Rate for Payer: Humana Commercial |
$1,466.25
|
| Rate for Payer: Humana KY Medicaid |
$593.23
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$599.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,414.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,273.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$605.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,518.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,293.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,500.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,190.25
|
| Rate for Payer: PHCS Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare All Payer |
$1,518.00
|
|
|
TIBIAL ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$1,725.00
|
|
|
Service Code
|
HCPCS 29855
|
| Hospital Charge Code |
76101091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$603.75 |
| Max. Negotiated Rate |
$1,279.44 |
| Rate for Payer: Aetna Commercial |
$1,163.20
|
| Rate for Payer: Ambetter Exchange |
$743.36
|
| Rate for Payer: Anthem Medicaid |
$637.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$743.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$743.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$892.03
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cigna Commercial |
$1,279.44
|
| Rate for Payer: Healthspan PPO |
$1,053.61
|
| Rate for Payer: Humana Medicaid |
$637.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$743.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$743.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$650.16
|
| Rate for Payer: Molina Healthcare Passport |
$637.41
|
| Rate for Payer: Multiplan PHCS |
$1,035.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$966.37
|
| Rate for Payer: UHCCP Medicaid |
$603.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$643.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$743.36
|
|
|
TIBIAL ARTHROSCOPY/SURGERY(P
|
Professional
|
Both
|
$1,725.00
|
|
|
Service Code
|
HCPCS 29855
|
| Hospital Charge Code |
761P1091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$603.75 |
| Max. Negotiated Rate |
$1,279.44 |
| Rate for Payer: Aetna Commercial |
$1,163.20
|
| Rate for Payer: Ambetter Exchange |
$743.36
|
| Rate for Payer: Anthem Medicaid |
$637.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$743.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$743.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$892.03
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cash Price |
$862.50
|
| Rate for Payer: Cigna Commercial |
$1,279.44
|
| Rate for Payer: Healthspan PPO |
$1,053.61
|
| Rate for Payer: Humana Medicaid |
$637.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$743.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$743.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$650.16
|
| Rate for Payer: Molina Healthcare Passport |
$637.41
|
| Rate for Payer: Multiplan PHCS |
$1,035.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$966.37
|
| Rate for Payer: UHCCP Medicaid |
$603.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$643.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$743.36
|
|
|
TIBIAL AUG #4 15MM LL/RM
|
Facility
|
IP
|
$4,156.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.88 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: Aetna Commercial |
$3,200.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,241.88
|
| Rate for Payer: Cash Price |
$2,078.12
|
| Rate for Payer: Cigna Commercial |
$3,449.69
|
| Rate for Payer: First Health Commercial |
$3,948.44
|
| Rate for Payer: Humana Commercial |
$3,532.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,408.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,067.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,246.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,657.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,117.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,325.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,615.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,867.81
|
| Rate for Payer: PHCS Commercial |
$3,990.00
|
| Rate for Payer: United Healthcare All Payer |
$3,657.50
|
|
|
TIBIAL AUG #4 15MM LL/RM
|
Facility
|
OP
|
$4,156.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.88 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: Aetna Commercial |
$3,200.31
|
| Rate for Payer: Anthem Medicaid |
$1,429.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,241.88
|
| Rate for Payer: Cash Price |
$2,078.12
|
| Rate for Payer: Cigna Commercial |
$3,449.69
|
| Rate for Payer: First Health Commercial |
$3,948.44
|
| Rate for Payer: Humana Commercial |
$3,532.81
|
| Rate for Payer: Humana KY Medicaid |
$1,429.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,443.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,408.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,067.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,246.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,458.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,657.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,117.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,325.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,615.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,867.81
|
| Rate for Payer: PHCS Commercial |
$3,990.00
|
| Rate for Payer: United Healthcare All Payer |
$3,657.50
|
|
|
TIBIAL AUG #4 15MM RL/LM
|
Facility
|
IP
|
$4,156.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.88 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: Aetna Commercial |
$3,200.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,241.88
|
| Rate for Payer: Cash Price |
$2,078.12
|
| Rate for Payer: Cigna Commercial |
$3,449.69
|
| Rate for Payer: First Health Commercial |
$3,948.44
|
| Rate for Payer: Humana Commercial |
$3,532.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,408.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,067.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,246.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,657.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,117.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,325.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,615.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,867.81
|
| Rate for Payer: PHCS Commercial |
$3,990.00
|
| Rate for Payer: United Healthcare All Payer |
$3,657.50
|
|
|
TIBIAL AUG #4 15MM RL/LM
|
Facility
|
OP
|
$4,156.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.88 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: Aetna Commercial |
$3,200.31
|
| Rate for Payer: Anthem Medicaid |
$1,429.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,241.88
|
| Rate for Payer: Cash Price |
$2,078.12
|
| Rate for Payer: Cigna Commercial |
$3,449.69
|
| Rate for Payer: First Health Commercial |
$3,948.44
|
| Rate for Payer: Humana Commercial |
$3,532.81
|
| Rate for Payer: Humana KY Medicaid |
$1,429.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,443.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,408.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,067.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,246.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,458.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,657.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,117.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,325.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,615.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,867.81
|
| Rate for Payer: PHCS Commercial |
$3,990.00
|
| Rate for Payer: United Healthcare All Payer |
$3,657.50
|
|
|
TIBIAL AUG NONPOROUS 1*10MM
|
Facility
|
OP
|
$9,380.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,814.06 |
| Max. Negotiated Rate |
$9,004.99 |
| Rate for Payer: Aetna Commercial |
$7,222.75
|
| Rate for Payer: Anthem Medicaid |
$3,225.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,316.56
|
| Rate for Payer: Cash Price |
$4,690.10
|
| Rate for Payer: Cigna Commercial |
$7,785.57
|
| Rate for Payer: First Health Commercial |
$8,911.19
|
| Rate for Payer: Humana Commercial |
$7,973.17
|
| Rate for Payer: Humana KY Medicaid |
$3,225.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,258.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,691.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,922.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,814.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,290.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,254.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,035.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,504.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,472.34
|
| Rate for Payer: PHCS Commercial |
$9,004.99
|
| Rate for Payer: United Healthcare All Payer |
$8,254.58
|
|
|
TIBIAL AUG NONPOROUS 1*10MM
|
Facility
|
IP
|
$9,380.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,814.06 |
| Max. Negotiated Rate |
$9,004.99 |
| Rate for Payer: Aetna Commercial |
$7,222.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,316.56
|
| Rate for Payer: Cash Price |
$4,690.10
|
| Rate for Payer: Cigna Commercial |
$7,785.57
|
| Rate for Payer: First Health Commercial |
$8,911.19
|
| Rate for Payer: Humana Commercial |
$7,973.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,691.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,922.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,814.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,254.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,035.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,504.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,472.34
|
| Rate for Payer: PHCS Commercial |
$9,004.99
|
| Rate for Payer: United Healthcare All Payer |
$8,254.58
|
|
|
TIBIAL AUG NONPOROUS 1*15MM
|
Facility
|
OP
|
$9,380.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,814.06 |
| Max. Negotiated Rate |
$9,004.99 |
| Rate for Payer: Aetna Commercial |
$7,222.75
|
| Rate for Payer: Anthem Medicaid |
$3,225.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,316.56
|
| Rate for Payer: Cash Price |
$4,690.10
|
| Rate for Payer: Cigna Commercial |
$7,785.57
|
| Rate for Payer: First Health Commercial |
$8,911.19
|
| Rate for Payer: Humana Commercial |
$7,973.17
|
| Rate for Payer: Humana KY Medicaid |
$3,225.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,258.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,691.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,922.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,814.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,290.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,254.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,035.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,504.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,472.34
|
| Rate for Payer: PHCS Commercial |
$9,004.99
|
| Rate for Payer: United Healthcare All Payer |
$8,254.58
|
|
|
TIBIAL AUG NONPOROUS 1*15MM
|
Facility
|
IP
|
$9,380.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,814.06 |
| Max. Negotiated Rate |
$9,004.99 |
| Rate for Payer: Aetna Commercial |
$7,222.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,316.56
|
| Rate for Payer: Cash Price |
$4,690.10
|
| Rate for Payer: Cigna Commercial |
$7,785.57
|
| Rate for Payer: First Health Commercial |
$8,911.19
|
| Rate for Payer: Humana Commercial |
$7,973.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,691.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,922.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,814.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,254.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,035.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,504.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,472.34
|
| Rate for Payer: PHCS Commercial |
$9,004.99
|
| Rate for Payer: United Healthcare All Payer |
$8,254.58
|
|
